| NPI | 1952432239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209013555) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: IL 041316365) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-05-04 |